A 30-year-old man arrives after a high-speed collision. He is intubated, BP 90/60 mmHg, HR 110 bpm, decreased breath sounds on the left with hyperresonance. Chest X-ray shows left-sided pneumothorax with mediastinal shift. What is the immediate management?
- A Needle thoracostomy in the 5th intercostal space, midaxillary line
- B Tube thoracostomy in the 5th intercostal space, midaxillary line
- C Needle thoracostomy in the 2nd intercostal space, midclavicular line ✓
- D Emergency thoracotomy
Correct answer: C. Needle thoracostomy in the 2nd intercostal space, midclavicular line
Explanation
Tension pneumothorax requires immediate needle decompression in the 2nd intercostal space, midclavicular line. This is a clinical diagnosis and treatment must not await imaging. Tube thoracostomy at the 5th intercostal space, midaxillary line is the definitive treatment but follows needle decompression. Emergency thoracotomy is not indicated for pneumothorax.
Reference: ATLS Advanced Trauma Life Support, 10th ed.
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Written and medically reviewed by the StethoPrep medical team.